Having a baby now runs insured families some $4,500 out-of-pocket, a figure that’s on the rise despite total maternity care costs remaining flat, researchers reported.
Average out-of-pocket costs for maternity care among women with employer-based insurance jumped to $4,569 in 2015 from $3,069 in 2008, largely due to higher deductibles, Michelle Moniz, MD, of the University of Michigan in Ann Arbor, and colleagues, reported in Health Affairs.
“I don’t take care of a lot of patients who have $4,500 lying around for unexpected healthcare costs,” Moniz told MedPage Today in an interview. The large number of women that are affected, the high out-of-pocket price tag, and the fact that around 45% of pregnancies are unplanned make these findings noteworthy, she added.
While the cost of having a baby remained stable in the U.S. from 2008 to 2015 ($29,518 and $29,314, respectively), patients are bearing a higher proportion of the expense. While patients paid about 12% of total maternity costs in 2008, they covered 20% of total maternity costs in 2015.
Kjersti Aagaard, MD, PhD, a maternal-fetal medicine specialist at Baylor College of Medicine in Houston, who was not involved in this study, said that when “total costs remain relatively the same, that you would have nearly one and a half times greater patient out-of-pocket expenses, that’s surprising.”
When the Affordable Care Act established maternity care as an essential health benefit, it required private insurance companies to cover certain pregnancy-related healthcare services, like screening for sexually transmitted infections and gestational diabetes. However, it allowed insurance companies to impose cost-sharing on patients in the form of copayments and deductibles.
To evaluate cost-sharing trends before and after implementation of this ACA policy, Moniz and colleagues used data from the Clinformatics Data Mart Database to analyze around 804,000 deliveries from 650,000 women in the U.S. with employer-based health insurance. The majority of the women in the study population were white, and 90% were ages 21 to 41. Researchers estimated average out-of-pocket spending by analyzing copayments, coinsurance charges, and deductible payments.
They found that from 2008 to 2015, mean out-of-pocket spending for a vaginal birth increased from $2,901 to $4,314, and from $3,364 to $5,161 for C-section deliveries. Much of the increase occurred before the ACA’s main insurance provisions began taking effect in 2011, at which point mean out-pocket costs for maternity care had reached nearly $4,000. Such costs accelerated from 2012 to 2013 but then nearly flattened in subsequent years.
Increased out-of-pocket costs were driven by an rise in deductible payments, Moniz and colleagues reported. Of all women who had a deductible payment, the average deductible for a vaginal birth increased by 62%, and for a cesarean delivery, average deductible payment rose by 72%. The proportion of women that paid a deductible jumped from around 69% to 87% from 2008 to 2015.
“It is patients that are covered by high deductible health plans that seem to be bearing a majority of the costs,” Moniz told MedPage Today.
Aagaard noted that the rise in out-of-pocket spending could force patients to make difficult decisions around prenatal care: “We don’t ever want our patients to be in a position of having to make difficult decisions, like choosing between preventative pregnancy care and basic cost of living,” she said.
Moniz and colleagues noted that their study was limited by the use of administrative data, and by calculating out-of-pocket spending via the use of standardized costs, which use allowed charges rather than actual charges.
Still, Moniz said the study suggests an opportunity for both state and federal policymakers to improve pregnancy-related insurance coverage.
“We would love to see maternity services in their entirety required to be covered with no out-of-pocket costs,” she said. “Reducing patient costs for these services makes common sense.”
Researchers Michelle Moniz and Vanessa Dalton received support from the Agency for Healthcare Research and Quality (AHRQ). Dalton is also a paid expert for the Bayer Corporation. Authors disclosed no other conflicts of interest.